Background and Aims 10% of polytraumatized patients have multiple rib fractures. Associated severe pain can lead to hypoventilation and respiratory complications in 31% of cases1. ‘Opioid-sparing analgesia’ as epidural and multimodal analgesia are recommended2. We hypotize that SAPB3,4 can provide effective, safe and long-lasting analgesia (thanks to dexamethasone added to local anaesthetic) and reduce respiratory complications, enhancing recovery of a better mechanical lung function.
Methods 15 patients(age 64±15) hospitalized for polytrauma with MRF(8±4) and severe pain(NRS> 4), impairing maximal inspiration and coughing, were treated with multimodal analgesia + SAPB(ethical committee approval obtained). We injected levobupivacaine 0.25% 30 ml and dexamethasone (8 mg) within the myofascial plane of serratus anterior. We registered respiratory rate(RR), heart rate(HR) and NRS at rest(NRSrest), during maximal inspiration(NRSdeep) and coughing(NRScough) before SAPB(T0), after 15 minutes(T1) and after 4 hours(T2). At T0 and T2, lung ultrasound(LUS) and diaphragmatic ultrasound(DUS) were performed. Incidence of opioid-related side effects and respiratory complications were recorded.
Results We observed a significant reduction in NRSrest, NRSdeep, NRScough, HR and RR at both T1 and T2 in all patients. LUS revealed a significant improvement in lung aeration, DUS showed a significant increase in diaphragm excursion. Duration of analgesia was greater than 30 hours in most patients, greater than 48 hours in almost 50%. No patient asked for rescue-analgesia. No patient had respiratory complications.
Conclusions Both clinical and instrumental data suggest that SAPB is safe and provides effective opioid-sparing analgesia. Pain reduction allows improvement in pulmonary aeration and diaphragmatic function, suggesting a possible role in prevention of pulmonary complications.
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